Sheen Soun, Hasan Prit, Sun Xiaowen, Wang Jian, Tatsui Claudio, Nouri Kent, Javed Saba
Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 01605, USA.
Department of Orthopedics and Physical Rehabilitation, The University of Massachusetts Chan Medical School, Worcester, MA 01610, USA.
J Clin Med. 2025 Apr 23;14(9):2908. doi: 10.3390/jcm14092908.
Percutaneous vertebral augmentation techniques, including vertebroplasty, kyphoplasty, and bone tumor radiofrequency ablation (BT-RFA), are commonly used to treat painful vertebral compression fractures (VCFs). While generally safe and effective, they carry risks, including cement extravasation, which can lead to pulmonary embolism or spinal cord compression. This study aims to compare the rate of cement extravasation across different vertebral augmentation techniques and identify potential risk factors. A retrospective cohort study was conducted at a comprehensive cancer center on 1002 procedure encounters in 888 patients who underwent vertebral augmentation for painful VCFs. Data were collected on patient demographics, fracture pathology, procedure type, imaging guidance, and pain scores. Intraoperative and postoperative imaging were manually reviewed to assess cement extravasation. Statistical analyses were performed using pairwise comparisons with Tukey's Honest Significant Difference adjustment to compare cement extravasation rates across the procedure groups and generalized linear mixed models to assess the association between the cement extravasation with other variables. : Cement extravasation occurred in 573 (57.2%) encounters. Kyphoplasty had the lowest rate of cement extravasation (46.2%) with significantly lower odds compared to vertebroplasty (OR: 0.42, 95% CI: 0.30-0.58; < 0.0001) and BT-RFA (OR: 0.57, 95% CI: 0.42-0.77; = 0.0009). Pathologic fractures and multilevel augmentations were linked to a 64% ( = 0.001) and 63% ( = 0.0003) increased odds of cement extravasation, respectively. Male sex and older age were protective factors. Cement extravasation is a common but largely asymptomatic complication of percutaneous vertebral augmentation. It is crucial to consider patient-specific risk factors when selecting an augmentation technique to optimize outcomes. Kyphoplasty may be the optimal choice for patients at increased risk of cement extravasation.
经皮椎体强化技术，包括椎体成形术、后凸成形术和骨肿瘤射频消融术（BT-RFA），常用于治疗疼痛性椎体压缩骨折（VCF）。虽然这些技术总体上安全有效，但也存在风险，包括骨水泥渗漏，这可能导致肺栓塞或脊髓压迫。本研究旨在比较不同椎体强化技术的骨水泥渗漏率，并确定潜在的风险因素。在一家综合癌症中心对888例因疼痛性VCF接受椎体强化治疗的患者的1002次手术进行了回顾性队列研究。收集了患者人口统计学、骨折病理、手术类型、影像引导和疼痛评分等数据。对术中及术后影像进行人工检查以评估骨水泥渗漏情况。采用两两比较及Tukey's真实显著性差异调整进行统计分析，以比较各手术组的骨水泥渗漏率，并使用广义线性混合模型评估骨水泥渗漏与其他变量之间的关联。结果显示：573例（57.2%）手术出现骨水泥渗漏。后凸成形术的骨水泥渗漏率最低（46.2%），与椎体成形术相比，其发生骨水泥渗漏的几率显著更低（比值比：0.42，95%置信区间：0.30 - 0.58；P < 0.0001），与BT-RFA相比也是如此（比值比：0.57，95%置信区间：0.42 - 0.77；P = 0.0009）。病理性骨折和多节段强化分别与骨水泥渗漏几率增加64%（P = 0.001）和63%（P = 0.0003）相关。男性和年龄较大是保护因素。骨水泥渗漏是经皮椎体强化术常见但大多无症状的并发症。在选择强化技术时考虑患者特定的风险因素以优化治疗效果至关重要。对于骨水泥渗漏风险增加的患者，后凸成形术可能是最佳选择。
